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Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study
  1. Elizabeth Rogawski,
  2. Leah McGrath,
  3. Nadja Vielot,
  4. Daniel Westreich
  1. Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Daniel, Westreich, Epidemiology, UNC-Chapel Hill, Chapel Hill, NC, USA; westreic{at}

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Dear Editor

Influenza vaccination is critical to public health, and vaccine uptake should be widely encouraged. The effects of vaccination on non-influenza-specific outcomes—for example, on risk of acute myocardial infarction (AMI)—nonetheless remain controversial. Several studies reported no difference in either initial myocardial infarction1 or recurrent coronary events among individuals who received influenza vaccination relative to those who did not.2 However, a recent meta-analysis of randomised control trials suggests that influenza vaccination may offer additional benefit by preventing cardiac events among high-risk patients.3

The recent observational study of ischaemic heart disease and influenza by MacIntyre et al4 also suggests a substantial benefit of vaccination on AMI in a more general population. The critical result of this study is that influenza vaccination dramatically reduces risk of AMI, reported as an OR of 0.55 in Table 3.4 This table also reports that influenza infection itself is not associated with AMI. The contrast of these results, derived from a single multivariate regression model, raises several methodological concerns.

The obvious mechanism by which influenza vaccine might prevent AMI is by preventing influenza infection; that is, infection is part of the hypothesised …

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  • Contributors ER and DW conceived the letter. ER wrote the first draft with input from DW. LMcG and NV contributed ideas and editing to the content and specifics of the letter. All authors reviewed and approved the final product.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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